Madam, the period of adolescence is nutritionally critical as pubertal growth spurt and cognitive development are modulated by nutritional status. Healthy eating and lifestyle habits developed in adolescence go a long way into adulthood reducing the burden of anaemia, osteoporosis and pregnancy related issues on the healthcare system.1,2 Unfortunately, in Pakistan,1 as in other developing countries,2 poverty rules the lives of the majority, joining hands with gender discrimination against adolescent girls, leaving them neglected, malnourished, underweight and anaemic. Experts have developed food pyramids and guidelines to aid healthy eating. Items like milk, eggs, fruits and meat are hardly affordable by the common man for every one of his many children, rendering these efforts fruitless and impractical in our setting. These cases make one wonder whether healthy eating is a right of the privileged only.
It is about time that we improvise solutions using the available resources to fulfill our own needs. The Tawana project, that addressed poor nutritional status of primary school girls in Pakistan, demonstrated that balanced meals can be achieved from locally available foods at nominal costs through training and empowerment of communities.3 A multi-sector approach is needed to conduct similar projects on a larger scale for adolescent girls. It is important to initiate mass awareness campaigns about the nutritional alternatives of the unaffordable food items, with emphasis on pulses and vegetables. A variety of vegetables and legumes should be included in diet to ensure getting all nutrients and amino acids.4 Organ meat is cheap and rich in both iron and vitamin B12. Taking iron rich green vegetables with brightly coloured vegetables rich in vitamin C maximizes iron absorption. Furthermore, awareness is needed about the iron chelating effects of tea and the importance of spacing it out in time from meals.2 Efforts should be made to decrease the trend of consuming items from road side vendors, chaalia (betel) and sweets, and save money to buy a fruit every now and then. Involvement of print and electronic media can greatly improve the effectiveness of such awareness programmes.
There are few trained nutritionists in the country. Emphasis should be laid on nutrition in medical school curriculum to equip future physicians with the knowledge to deal with this issue. Families should be counseled with facts to counter their gender discriminating beliefs. These are not lost cases, destined to succumb to circumstances; rather they should be helped to make the most of their means.
Class of 2009, Aga Khan University Medical College, Karachi.
1.Khan A. Adolescents and reproductive health in Pakistan: a literature review. Islamabad: Population Council and United Nations Population Fund, 2000.
2.WHO Regional Office for the South-East Asia. Adolescent Nutrition: A review of the situation in selected South-East Asian countries. New Dehli: WHO 2006.
3.Badruddin SH, Agha A, Peermohamed H, Rafique G, Khan KS, Pappas G. Tawana project-school nutrition program in Pakistan- its success, bottlenecks and lessons learned. Asia Pac J Clin Nutr 2008; 17: 357-60.
4.Khor GL. Food-based approaches to combat the double burden among the poor: challenges in the Asian context. Asia Pac J Clin Nutr 2008; 17: 111-5.